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Groundbreaking Report Opens Discussion About Health Care in Brazilian Community

The Island's growing population of Brazilian immigrants came here in large part to better their economic condition, but a study released last week shows that in many cases the endeavor is taking a serious toll on their health.

Strangers in a foreign land and frequently toiling long hours at physically demanding jobs, a significant percentage of the 168 Brazilians who took part in the health survey are suffering from depression, chronic lower back pain, migraine headaches and tick bites.

The survey, undertaken by the Island Health Plan and the Vineyard Health Care Access Program, also offers the first statistical glimpse into the year-round Brazilian community, which is estimated at between 2,000 and 2,500 people - accounting for more than 10 per cent of the Island population. Neither town nor federal census data collects specific information on the Vineyard's Brazilian community.

But the Martha's Vineyard Brazilian Health Report is a start.

"Overall, the Brazilian sample is young, has low educational and income levels, but has good social support related to relationships, the majority married or living with a significant other," stated the report. It was written by Dr. Elizabeth Benito-Garcia, a rheumatologist and public health researcher at Brigham and Women's Hospital in Boston.

The average age of those responding was 34 years. Fifty-nine per cent were male. According to the report, 26 per cent work in the construction business. Another 26 per cent earn money by cleaning houses, the majority of them women. And 20 per cent work as landscapers.

Some have lived on the Vineyard 15 years while others arrived just a month before answering questions on the 17-page survey. Slightly more than half - 56 per cent - cannot speak English. Only nine per cent have a college or university education, while 40 per cent have less than a high school education. Of those surveyed, 67 per cent said they are earning less than $30,000 a year.

Health advocates who organized the survey say the report fills a gap. The Health Report of Martha's Vineyard, completed last summer through a collaboration of health agencies, received surveys from 1,054 year-round Vineyard residents and 690 seasonal residents but excluded the non-English speaking population.

"This was a segment of the population that needed to be included but there weren't the resources there to have the questionnaire translated into Portuguese," said Sarah Kuh, director of the health care access program, a county-run agency based in Oak Bluffs. "The impact of having a substantial immigrant community with limited English proficiency on the health care system is poorly understood."

The Brazilian health report, paid for by a $15,000 grant from the Blue Cross Blue Shield Foundation of Massachusetts and a $7,500 outreach grant from the Island Health Plan, quickly targeted access as a major problem. Brazilians reported that they are not seeking medical treatment because they cannot afford it and because of language barriers.

The upshot is obvious. Brazilians are not receiving the same kind of health care as the rest of the residents on the Vineyard.

Of those surveyed, only 28 per cent said they had seen a physician for a regular checkup in the last year, while 75 per cent of the Islanders surveyed for the Martha's Vineyard Health Report said they had seen a doctor for a checkup in the last year.

Twenty-six per cent said they receive regular treatment from a physician on the Island, while another 26 per cent opt for treatment off-Island, nearly all of them receiving care in Brazil. Just under half said they do not see anyone for regular health care.

On the preventive medicine front, between 54 and 73 per cent of Brazilian women had sought breast exams, mammograms and pap smears. The report credited the work done by the women's health network at the Visiting Nursing Association where bilingual outreach workers conduct the screenings at no charge.

The dominant health problems - headaches, depression and back pain - appear to be related to the stressful lives led by a portion of the Brazilian population on the Vineyard.

"They work like dogs in the summer and stay at home in the winter. They work like 75 to 100 hours a week," said Jakeline Oliveira, a full-time receptionist and medical interpreter at Island Health Care, the rural health clinic that opened last winter at the Triangle in Edgartown. Roughly 40 per cent of the clinic's patients are Brazilian.

Ms. Oliveira came to the Vineyard in 2003 via New York city, where she had lived since she emigrated from Brazil in 1996. She contends that the majority of Brazilians on the Island came here illegally, crossing the Mexican border and paying upwards of $12,000 for the transport. The result, she said, is an enormous financial pressure to pay back that debt.

"They don't have documents. It's pressure all the time," she said. "They come and think they will make money fast."

Carol Anne Lindsey, the physician's assistant at the health clinic, zeroed in on those pressures as the root cause of the depression experienced by some of the immigrants.

"The stress here is unbelievable for these people," she said. "It is lonely. It is cold. There are no Portuguese-speaking counselors beyond the church. There's no psych support. And you couldn't have a population less interested in taking a pill for depression.

"They're living in a cold place where people resent them and look down on them," she continued. "Many live in group homes . . . in crowded living conditions . . . which would be hard for anybody."

Ms. Lindsey is also concerned about the Brazilians' high exposures to ticks and the consequent risks for Lyme disease and other tick-borne illnesses. While 36 per cent reported finding a tick on their skin and four per cent reported actual tick bites, only one per cent said they ever had a tick-borne disease. Only 20 per cent said they check their body ticks after spending time in wooded areas.

"I have some patients who presented with tick bites and three or four years later, they have chronic Lyme," said Ms. Lindsey.

Ms. Lindsey challenged people who claim that the Brazilian population is burdening the health care system and eating up resources for free care.

"There's a suspicion that the Brazilians are draining the free care pool. That's absurd. We have many non-Brazilians who qualify for and use the free care pool," she said.

According to the health report, 70 per cent of the Brazilians surveyed said they had not used the hospital for emergency services within the past two years, while the remaining 30 per cent said they had used these service one or more times for an urgent or critical medical need. Only three per cent said they had been hospitalized for an overnight stay at the facility.

The key to solving some of these problems, said the Island health advocates, is better communication and a concerted effort to bridge the language divide.

The Martha's Vineyard Hospital currently uses the AT&T language line for medical interpretation and spends about $10,000 annually for the service.

But among the four health care providers who responded to the survey (20 had been contacted), the consensus was that language problems hindered their abilities to treat Brazilian patients.

"For the most part, Brazilian patients are the only ones that do not speak English," the report stated.

The Island Health Plan and Vineyard health access program have already secured a $50,000 grant from the Blue Cross foundation to implement a community-based interpreter program, which they hope to launch by the fall.

Meanwhile, Ms. Oliveira stressed the need for Brazilians to try to learn English as a way to improve their mental health. "We need to learn the language," she said. "And you can feel better."